Walking Together on a Path of Transformation Soma Stout, MD MS Executive Lead, 100 Million Healthier Lives, Institute for Healthcare Improvement Lead Transformation Adviser, Cambridge Health Alliance November 17, 2015 Portland Oregon Coordinated Care Summit
Cambridge Health Alliance (CHA) Trainees Customers Public health (actively engaged (50% speak language in creating other than English transformation) 70% publicly insured) Integrated care delivery system serving 100,000 patients (12 community clinics, 2 hospitals, 3 EDs, specialty sites) Community 3393 Employees (7 cities) (in 18 labor unions)
Our model of transformation Shared Medical savings home and and global neighbor- payments hood Scale Partnerships HIT Culture INFRASTRUCTURE
Relationships + improvement approach + system transformation = outcomes
Cambridge Health Alliance Experience • Improved experience • 10% reduction in total cost (15% reduction compared to rest of network for Medicaid managed care) • Improved quality health outcomes for a safety net population to above the national 90%ile • Improved joy and meaning of work for the workforce • Was chosen as one of four innovative and effective transformations in the country by HHS
36% Reduction In Hospitalization Rate For Patients With Diabetes
The context of our communities
The need for a life course view • Exposure to toxic stress in early childhood may lead to as much as a 40x increase in rate of chronic disease by the time you’re 50.
Cycle of violence, substance abuse, incarceration and reincarceration 1 in 5 people are 76% prisoners released addicted to a are rearrested substance in Revere “School to prison pipeline”
Equity as a System Property • The life expectancy of Denmark and Zambia in the space of a few miles • 10 - 25 year difference in life expectancy depending on where you are born. • Poverty is a huge factor in disparities. • Race widens the disparity gap inherent in poverty
Childhood Asthma • Partnership between schools, public health, and primary care • Clear accountability for every child, shared registry • Partnership with school nurses • Proactive outreach to patients by the primary care team to get them controlled on asthma medications. • Healthy Homes assessment through public health partnership.
Childhood Asthma Outcomes: Seeing Admissions And ED Visits As A Safety Issue Childhood Asthma: Childhood Asthma: % Patients with Asthma ED Visits % Patients with Asthma Admissions Pilot Sites (PEDO & SOPED) Rest of CHA Pilot Sites (PEDO & SOPED) Rest of CHA 12% 25.0% 10% % Patient Count 20.0% % Patient Count 8% 15.0% 6% 4% 10.0% 2% 5.0% Goal <=0.5% Goal <= 2% 0% 0.0% Jan-2002 Jan-2003 Jan-2004 Jan-2005 Jan-2006 Jan-2007 Jan-08 Jan-09 Jan-2002 Jan-2003 Jan-2004 Jan-2005 Jan-2006 Jan-2007 Jan-08 Jan-09 (N-Pilot = 125) (N-Pilot =369) (N-Pilot = 479) (N-Pilot=596) (N-Pilot = 926) (N-Pilot = 1097) (N-Pilot = 1 25) (N-Pilot =369) (N-Pilot = 479) (N-Pilot=596) (N-Pilot = 926) (N-Pilot = 1 097) (N-Rest = 1 8) (N-Rest = 30) (N-Rest = 209) (N-Rest = 643) (N-Rest = 880) (N-Rest = 889) (N-Rest = 18) (N-Rest = 30) (N-Rest = 209) (N-Rest = 643) (N-Rest = 880) (N-Rest = 889)
A spiral of collaboration and outcomes • Tobacco • Obesity • Health and wellbeing of the elderly • Mental health • Substance use • Breaking the cycle of violence and incarceration
100 Million Healthier Lives Identity: An unprecedented collaboration of change agents pursuing an unprecedented result: 100 million people living healthier lives by 2020 Vision: to fundamentally transform the way we think and act to improve health, wellbeing and equity.
Theory of change – 100 Million Healthier Lives Unprecedented collaboration Innovative 100 Million People Living improvement Healthier Lives by 2020 System transformation
Interrelationship between the health, wellbeing and equity of people, communities and populations Individual, family, social health and wellbeing Health, wellbeing and equity Community Societal health health and and wellbeing wellbeing 100 Million Healthier Lives
Our Broad Measurement Framework
Shared priorities “9 What’s” 1. Close equity gaps (price of admission) 2. Help veterans to thrive 3. Address and improve social determinants across the continuum 4. Improve wellbeing of indigenous communities 5. Help all kids have a great start to life 6. Make mental health everybody’s job and take a prevention approach 7. Engage people in their own health (nutrition, exercise, sleep, stress, food security) 8. Improve employee health and wellbeing 9. Create wellbeing in the elder years and end of life
“9 Hows ” 1. Shift culture and mindset 2. Develop the health workforce 3. Elevate peer to peer approaches 4. Build improvement capability at the community level 5. Use chronic diseases and risk factors to build the health continuum 6. Improve high quality primary health care access for all 7. Integrate data across siloes 8. Create new financing strategies 9. Transform health care to be great at health and great at care
What if we did not see ourselves as alone in improving the health and wellbeing of our citizens?
LinkAges Big White Wall https://vimeo.com/83703623 St Ninian’s https://www.utec-lowell.org/gallery/video
We invite you to Join the movement (www.ihi.org/100MLives) 1. Collaborate and know that you are not alone 2. • With each other • With others across sectors who hold a piece of the puzzle. Create a vision and set measurable aims; learn your way to getting there. 3. Be part of changing the systems that don’t work – there is no such thing 4. as an intractable problem. Make improving equity part of your life’s work. 5.
24 www.ihi.org/100MLives Soma Stout, sstout@ihi.org
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